tbuckley/cabot-search huggingface dataset:
Abstract 178: Development And Validation Of The Utstein-based Machine Learning Algorithms To Predict Neurological Outcomes After Out-of-hospital Cardiac Arrest: A Retrospective Analysis Of The Pan-asian Registry
Authors: Tsung-Chien Lu, Chih-Hung Wang, Fan-Ya Chou, Eric H Chou, Chu-Lin Tsai, Matthew Huei-Ming Ma
Journal: Circulation (2022)

Introduction: The proportion of favorable neurologic outcome from the survival after Out-of-Hospital Cardiac Arrest (OHCA) remains poor, esp. in the Asian communities. By using the machine learning (ML) approach, we aimed to develop and validate the the Utstein-based ML algorithms to predict neurological outcomes after OHCA in this population. Methods: We conducted a retrospective analysis of data collected from the registry of Pan Asian Resuscitation Outcomes Study (PAROS) Network, an international and multi-center cohort study of OHCA across 13 countries in this region. All adult (≥ 18 years) EMS-treated OHCA patients between Jan 2009 to May 2018 in the registry were included, with variables followed the Utstein recommendations and conform to a unified taxonomy established by the network. The primary outcome was defined as good neurological outcome with cerebral performance category 1 or 2. Random splitting was used to divide the dataset into the training/validation and testing cohorts at around 2-to-1 ratio. Four supervised ML models, including Random Forest (RF), Gradient Boosting (GB), Extra Trees (ET), and CatBoost (CB) classifiers were employed to construct the prediction models, and performances were evaluated and compared with traditional logistic regression (LR) by the area under the receiver operating characteristic curve (AUC) in the testing cohort. Results: We included 194,300 records for analysis. Of them, 6,342 (3.3%) achieved good neurologic outcome. Among the constructed ML models, RF obtained the best AUC performance (0.924, 95% CI: 0.917-0.932), followed by ET (0.922, 95% CI: 0.915-0.930), CB (0.922, 95% CI: 0.915-0.930), and GB (0.910, 95% CI: 0.901-0.920). Although there was no difference in performance between each ML models, RF performed significantly better than using the traditional LR. The top important features were first arrest rhythm, age, witnessed by EMS, event location, and duration from call to EMS arrival. Conclusions: The ML approach showed excellent discriminatory performance to predict good neurologic outcome for EMS-treated OHCA patients in the Pan-Asian communities. It has the potential to save more life or provide termination-of-resuscitation if successfully implemented in the EMS system.
Abstract 14430: Sex Differences in Heart Transplantation - Analysis of the National Inpatient Sample 2012-2019
Authors: Nakeya Dewaswala, Huzefa Bhopalwala, Abdul M Minhas, Josue Villegas-Galaviz, Samiullah Arshad, Adnan Bhopalwala, Sourbha Dani, Andrew Kolodziej, Erin D Michos, Emma Birks, Gaurang Vaidya
Journal: Circulation (2022)

Introduction: Advanced heart failure therapies and heart transplantation (HTx) have been underutilized in women. Therefore, we aimed to explore the clinical characteristics and outcomes of HTx by sex. Methods: We conducted a retrospective analysis of adult discharges from the National Inpatient Sample (NIS) between 2012 and 2019. International Classification of Disease (ICD) procedure codes were used to identify those who underwent HTx. Results: A total of 20,180 HTx hospitalizations were identified from 2012-2019. Among them, 28% were female. Women undergoing HTx were younger (mean age 51 vs. 54.5 years, p&lt;0.001). HTx hospitalizations among men were more likely to have atrial fibrillation, diabetes, hypertension, renal failure, dyslipidemia, smoking, and ischemic heart disease. HTx hospitalizations among women were more likely to have hypothyroidism and valvular heart disease. HTx hospitalizations in women were associated with no significant difference in risk of in-hospital mortality (adjusted odds ratio [OR] 0.82; 95% confidence interval [CI] 0.58-1.16, p=0.271), no significant difference in length of stay or inflation-adjusted cost as shown in the Table. Men were more likely to develop acute kidney injury during HTx hospitalization (69.2% vs. 59.7%, adjusted OR 0.71, 95% CI 0.61-0.83, p&lt;0.001). Conclusions: HTx utilization is lower in women. However, most major in-hospital outcomes for HTx are similar between the sexes. Further studies are need to explore the causes of lower rates of HTx in women.
Abstract 15258: An Unobvious Benefit of the Coexistence of Arterial Hypertension and Atrial Fibrillation - Results of Nationwide Cross-Sectional Study From Central and Eastern Europe
Authors: Piotr Zieleniewicz, Zbigniew Kalarus, Grzegorz Opolski, Beata Sredniawa, Jakub Stokwiszewski, Lukasz Wierucki, Jaroslaw Kazimierczak, Tomasz Grodzicki, Tomasz Zdrojewski
Journal: Circulation (2022)

Introduction: Poland represents the region of Central and Eastern Europe with high cardiovascular risk and a rapidly aging population with an ever-increasing prevalence of arterial hypertension (AH) and atrial fibrillation (AF). Our study describes the epidemiology of these conditions and factors associated with AF in the elderly. Methods: In a representative sample of 3014 Poles aged 65 years and over (mean age 77.5 years old, 49.1% women) questionnaire data, blood pressure measurements and blood samples were taken. Hypertension was defined as mean SBP ≥140mmHg or DBP ≥90mmHg or treatment of hypertension. Each patient was screened for AF by continuous ECG monitoring for up to 30 days using a validated ECG vest. Results: Overall prevalence of AH was 80.9% and overall prevalence of AF was 19.2%. Both conditions coexisted in 16.7% of participants and AF with no AH was observed in only 2.5% of participants. Hypertension was significantly more common in patients with AF than in these without AF (87.1% vs 79.4%, p&lt;0.05). Mean systolic blood pressure and pulse pressure were significantly lower in the AF population (139.7 mmHg vs 142.6 mmHg, p&lt;0.05, 61.3 mmHg vs 63.9 mmHg, p&lt;0.05 respectively). In hypertensive patients the AF was more often paroxysmal than persistent/permanent (11.9% vs 8.8%, p&lt;0.05), but the episodes of paroxysmal AF lasted longer than in patients without AH (14.9 hours vs 7.6 hours in men, p&lt;0.05; 11.2 hours vs 3.5 hours in women, p&lt;0.05). Participants with coexisting AF and AH were more often aware of both AF (79.9% vs 69.2%, p&lt;0.05) and AH (88.9% vs 84.1%, p&lt;0.05). Significant factors associated with AF occurrence in hypertensive patients were heart failure (OR 2.91), male gender (OR 1.94), elevated NT-proBNP level (OR 1.73), diabetes (OR 1.44), hyperthyroidism (OR 1.44), obesity (OR 1.34), chronic kidney disease (OR 1.32), ischemic heart disease (OR 1.31) and age (OR 1.04). Conclusions: Hypertension and atrial fibrillation are widespread in the elderly population and coexist in one in six people aged 65 years and older. This coexistence is associated with better blood pressure control and disease awareness.
Abstract 14468: Which Measure of Right Ventricle Assessment Should Be Used in COVID19 to Predict In-Hospital Mortality?
Authors: Riaz Mahmood, Abdullah Asreb, Parijat S Joy, Gagan Kumar
Journal: Circulation (2022)

Introduction: Right ventricle failure is one of the features of severe COVID19 which is associated with poor outcomes. Measurement of failing right ventricle (RV) is difficult, and the few measures that have been used to study RV include tricuspid annular plane systolic excursion (TAPSE), right ventricle systolic pressure (RVSP) and RV dilation. There is limited data with regards to which of these parameters should be used to predict mortality in COVID19. Hypothesis: low TAPSE, high RVSP, and higher dilation are associated with higher in-hospital mortality. Methods: We performed a retrospective chart review of patient hospitalized with COVID-19 infection and underwent echocardiography (ECHO) within the Northeast Georgia Health System from March 2020 to December 2021. The primary outcome was in hospital mortality. RV dilation was classified as none, mild, moderate, and severe. TAPSE and RVSP were used as continuous variable in univariate analysis. We used multivariable cox regression model and adjusted for demographical characteristics and underlying co-morbidities, along with the three RV failure parameters. We used interaction terms between the parameters to identify which parameter correlated with mortality. For interaction, we classified TAPSE into 4 group - &lt;1.2; 1.2 to 1.5; 1.5-1.8 and &gt;1.8. Results: In total 7939 patients were identified with COVID-19 infection and of these, 3,109 underwent ECHO. Of these 56% were males and mean age was 65.6 years (SD 15.1 years). In hospital mortality was 25.9%. On univariate analysis, TAPSE (HR 0.71, 95%CI 0.61-0.84), RV dilation (HR 1.11, 95%CI 1.04-1.19) were strongly associated while RVSP (HR 1.01, 95%CI 1.00-1.01) was poorly associated with in-hospital mortality. On multivariable cox regression model with interaction, TAPSE &lt; 1.2 along with moderate to severe RV dilation was associated with in hospital mortality (HR 1.88, 95%CI 1.25-2.8, p=0.002). Dilated RV was still associated with in-hospital mortality even when TAPSE was higher than 1.2 (HR 1.56, 95%CI 1.01-2.4, p=0.04). Conclusions: Moderate to severe Dilation of RV and TAPSE &lt; 1.2 were strongly associated with an increase in mortality. Moderate to severe dilation of RV was also associated with increased mortality with TAPSE between 1.2 to 1.8.
Abstract 13639: Bivalirudin versus Heparin in Patients With STEMI Undergoing PCI: Individual-Patient-Data Pooled Analysis of the 6 Major Randomized Trials
Authors: Behnood Bikdeli, Marco Valgimigli, David Erlinge, Adnan Kastrati, Philippe G Steg, Han Yaling, Rod Stables, Roxana Mehran, Enrico Frigoli, Stefan K James, GOLDSTEIN patrick, Yi Li, Adeel Shahzad, Stefanie Schuepke, Shmuel Chen, Ghazaleh Mehdipoor, Bjorn Redfors, Aaron Crowley, Zhipeng Zhou, Gregg Stone
Journal: Circulation (2022)

Background: Given differences in prior trial designs, the treatment tradeoffs between bivalirudin and heparin in patients with STEMI undergoing PCI remain uncertain. Study-level meta-analyses lack granularity to provide conclusive answers or assess subgroups. Methods: We performed an individual-patient-data pooled analysis from all 6 large (n&gt;1000) RCTs of bivalirudin vs heparin in STEMI pts undergoing PCI (BRIGHT, EUROMAX, HEAT-PPCI, HORIZONS-AMI, MATRIX, and VALIDATE-SWEDEHEART). The primary efficacy outcome was the 30-day rate of all-cause mortality. Subgroup analyses were performed according to planned use of glycoprotein IIb/IIIa inhibitors (GPI), and administration of a post-PCI bivalirudin infusion. Results: A total of 15,254 patients with STEMI undergoing PCI were included (7,306 randomized to bivalirudin and 7,948 to heparin [43.6% with planned GPI use]). Thirty-day mortality was not significantly different between bivalirudin vs heparin (aHR: 0.80; 95% CI: 0.64, 1.01); 30-day cardiac mortality was reduced with bivalirudin (aHR: 0.72; 95% CI: 0.57, 0.91). There was a higher risk of 30-day MI (aHR: 1.29, 95% CI: 1.02, 1.64) and stent thrombosis (aHR: 1.42; 95 % CI: 1.05, 1.91) but lower risk of serious bleeding (aHR: 0.57 (0.47, 0.68) with bivalirudin vs heparin. At 1 year, net adverse clinical events were reduced with bivalirudin (aHR: 0.84; 95% CI: 0.77, 0.93) (Table). All-cause mortality was reduced with bivalirudin when a post-PCI infusion was used. A high-dose post-PCI infusion mitigated the 30-day MI and ST risks, irrespective of planned GPI use with heparin. Conclusions: In patients with STEMI undergoing PCI, procedural anticoagulation with bivalirudin did not reduce all-cause mortality. Cardiac mortality and serious bleeding were reduced with bivalirudin at the cost of increased rates of MI and ST. Full analyses will be presented at AHA 2022.
Abstract 14630: Cigarette Smoking and Risk of Carotid Atherosclerotic Lesions Among Chinese Adults With or Without Cardiometabolic Disorders: A Longitudinal Study
Authors: Mingyu Song, Jieyu Liu, Meng Xiao, Yueqing Wang, Haiming Yang, Yuxuan Zhao, Canqing Yu, Yuan Ma, Jun Lv, Liming Li, Bo Wang, Dianjianyi Sun
Journal: Circulation (2022)

Backgroud: Cigarette smoking is closely associated with the presence of carotid atherosclerotic lesions (CAL); however, whether such association differs in participants with or without cardiometabolic disorders (CD) is largely unknown. Methods: A dynamic retrospective cohort study of health checkup data was used from the Beijing MJ Health Screening Centers. A total of 14 410 participants were included among those who took both routine tests and carotid ultrasonography (CU) at least twice from 2008 to 2018 and had no CAL at the first time. Information on smoking status was collected from self-reported questionnaires. CAL was defined as increased carotid intima-media thickness, carotid plaques, or carotid stenosis. CD was defined with the presence of hypertension, diabetes, and/or dyslipidemia. The associations of smoking with CAL among participants with or without CD and the joint effect of smoking and CD were estimated by logistic regression. Results: Among 5810 and 8600 participants with and without CD at baseline, 2016 and 1386 developed CAL during follow-up, respectively. We found the status of CD significantly modified the associations between smoking and CAL ( P interaction &lt; 0.01). Among participants without CD, non-current smoking was independently associated with a decreased risk of CAL (odds ratio [OR] and 95% confidence interval [CI]: 0.80 [0.68-0.94]). Whereas, such association was not observed among CD patients. In joint analyses, compared with current smokers with CD (CD + &amp;smoking + ), the ORs (95% CIs) were 0.72 (0.61-0.84), 0.94 (0.82-1.07), and 0.56 (0.49-0.64) for participants in the CD - &amp;smoking + , CD + &amp;smoking - , and CD - &amp;smoking - group, respectively. Conclusion: Never and former smokers without CD might have a lower risk of CAL, but not the ones prevalent with CD, highlighting the carotid atherosclerotic benefits of early smoking cessation.
Abstract 15577: Clinical Outcomes in Hypertensive Emergency: A Systematic Review and Meta-Analysis
Authors: Tariq J Siddiqi, Muhammad Shariq S Usman, Ahmed Mustafa Rashid, Aymen Ahmed, Donald Clark, John M Flack, Daichi Shimbo, Daniel W Jones, Michael E Hall
Journal: Circulation (2022)

Introduction: Despite the increasing rate of hypertensive emergency (elevated blood pressure with acute target organ damage) presentations in the emergency department (ED), subsequent morbidity and mortality data to support clinical decision making remains scarce. We aim to study the prevalence and prognosis of hypertensive emergencies and hypertension mediated organ damage (HMOD) in patients presenting to the ED. Methods: PubMed and Scopus were queried from their inception through the mid of November 2021. Studies were included if they reported the prevalence or prognosis of hypertensive emergencies in patients presenting to the ED. Data from each study was arcsine-transformed and pooled using a random-effects model. Results: Fourteen studies (n = 4370 patients) were included in our analysis. Pooled analysis demonstrates that the prevalence of hypertensive emergencies was 0.5% (95% CI: 0.40 - 0.60) in patients presenting to ED. Ischemic stroke 28.1% (95% CI: 18.7 - 38.6), was the most prevalent HMOD, followed by pulmonary edema/acute heart failure 24.1%, (95% CI: 19.0 - 29.7, hemorrhagic stroke 14.6%, (95% CI: 9.9 - 20.0), acute coronary syndrome 10.8%, (95% CI: 7.3 - 14.8), renal failure 8.0%, (95% CI: 2.9 - 15.5), subarachnoid hemorrhage 6.9%, (95% CI: 3.9 - 10.7), encephalopathy 6.1%, (95% CI: 1.9 - 12.4), and the least prevalent was aortic dissection 1.8%, (95% CI: 1.1 - 2.8) ( Figure ). Mortality rate among patients admitted to the hospital due to hypertensive emergency was 9.9% (CI: 1.4 - 24.6). Conclusions: Our findings demonstrate substantial morbidity and mortality amongst patients presenting to the ED with hypertensive emergency. Results of studies may help clinicians identify organs at highest risk of damage in patients with hypertensive emergency, aiding the work-up and therefore helping curb the burden of this disease.
Abstract 14841: Perm1 is a Novel Regulator of O-GlcNAcylation in the Heart
Authors: KARTHI SREEDEVI, Thirupura S Shankar, Shreya Yedla, Amina James, sumaita arowa, Alexey V Zaitsev, Yukio Saijoh, Stavros G Drakos, Junco S Warren
Journal: Circulation (2022)

Background. Perm1 is a striated-muscle specific protein that is predominantly expressed in cardiac and skeletal muscle. We recently demonstrated that Perm1 is downregulated in the human and mouse failing hearts. However, whether and how Perm1 regulates cardiac function remains unknown. Beta-O-linkage of N-acetylglucosamine (O-GlcNAc) post-translational modification plays a role in stress response, and the excessive O-GlcNAc in the heart leads to the development of heart failure. We hypothesize that Perm1 regulates cardiac function through O-GlcNAcylation. Methods and Results. Our newly generated Perm1-knockout (KO) mice exhibited reduced cardiac function as compared to their wild-type (WT) littermates (50.1% vs. 34.7% in ejection fraction, p&lt;0.05, n=15/group), which was associated with a significant increase in the total levels of O-GlcNAcylated proteins (139% from WT, p&lt;0.05, n=6 in WT, n=8 in KO). To determine whether Perm1 downregulation increases the vulnerability to pressure overload, WT and Perm1 heterozygous (Perm1 +/- ) mice were subjected to transverse aortic constriction (TAC) surgery for 1 week. The total O-GlcNAcylated protein levels were markedly increased in Perm1 +/- -TAC mice as compared to WT-TAC mice (549% vs. 173% from non-TAC WT, p&lt;0.05, Fig.1A, B), concurrent with lower ejection fraction than WT-TAC mice (50.0% vs. 41.5%, p=0.06, n=5 in WT-TAC, n=3 in Perm1 +/- -TAC). The excessive O-GlcNAc in Perm1 +/- mice was associated with upregulation of O-GlcNAc transferase (OGT, the enzymes that adds O-GlcNAc to proteins, p&lt;0.05, Fig1A, C), while there was no significant difference in the expression of O-GlcNAcase (OGA, the enzyme that removes O-GlcNAc from proteins) in WT vs. Perm1 +/- mice in post-TAC (Fig.1A, D). Conclusions. These data suggest that Perm1 suppresses excessive O-GlcNAcylation occurring in a stressed heart through regulating OGT expression. Hence, the maintenance of Perm1 expression may be protective in the failing heart.
Abstract 14813: Insulin Resistances in Patients With Fontan Palliations
Authors: Erin V Shea, Sunkyung Yu, Kurt R Schumacher, Ray Lowery, Tammy Doman, Albert P Rocchini
Journal: Circulation (2022)

Introduction: Patients (pts) with single ventricles who have undergone Fontan palliation are surviving longer and at increased risk for acquired morbidly. Insulin resistance (IR) and abnormal glucose metabolism are known to be predictors of cardiac morbidity and mortality. Limited studies suggest that IR and metabolic syndrome occur in individuals following Fontan palliation. This study aimed to evaluate IR in Fontan pts. Methods: In this prospective, single-center, case-control study, Fontan pts and controls were recruited during clinic or catheterization visits between 6/2021 - 2/2022. Individuals with diabetes mellitus, pregnancy, steroid use, inotropic support, or surgery within the last 6 months were excluded. Control subjects were eligible if they had 2 ventricle circulation and did not have heart failure or systemic illness. Demographic and clinical data were collected via chart review. Fasting serum glucose and insulin were acquired at their visit. Group comparisons were made in IR via natural log-transformed homeostasis model assessment, ln(HOMA-IR), and QUICKI (1/[log(Insulin) + log(Glucose)]), without/with adjusting for age. Results: In total 89 pts (59 Fontan and 30 controls) were included, with median age of 20.2 yrs (interquartile range 15-28.1). Fontan pts showed significant elevation of ln(HOMA-IR) (0.82±0.62 vs 0.24±0.44) and decrease in QUICKI (0.34±0.03 vs 0.37±0.02) compared to controls (both p&lt;.0001); this remained significant even controlling for age (both p≤0.02). Analysis excluding Fontan pts with obesity still showed significant elevation of ln(HOMA-IR) and reduction of QUICKI in Fontan pts compared to controls when adjusting for age (both p&lt;0.05). With older age there was an increase in ln(HOMA-IR) (mean 0.2 in age &lt; 13 yrs vs. 0.53 in age 13-18 yrs vs. 0.78 in ag &gt; 18 yrs, p=0.01). Using a QUICKI &lt; 0.339 defining IR, there was an increase proportion of IR with older age (7% in age &lt; 13 yrs vs. 26% in age 13-18 yrs vs. 48% in age &gt; 18 yrs, p=0.01). Conclusions: Fontan pts had significant elevation in IR compared to controls using standard clinical IR serum testing that was independent of age. Additionally, IR continues to increase with age. Further evaluation is needed to understand risk for IR in pts undergoing Fontan palliation.
Abstract 15236: A Systematic Review of the Quality of Life (QOL) Assessment Tools Used in Aortic Dissection in the Context of Survivorship
Authors: lydia hanna, Rama Jha, Viknesh Sounderajah, Sheraz Markar, Richard Gibbs
Journal: Circulation (2022)

Introduction: The term 'survivorship' describes the therapeutic, functional, psychosocial, and financial experience of living with a chronic condition.This term acknowledges the fact that a patient’s life can be radically altered overnight because of their disease and treatment, but also designates patients as ‘survivors’, having overcome the acute phase (‘acute survivorship’) and now needing to live with, through and beyond their condition (‘extended survivorship’ and ‘permanent survivorship’). The aim of this systematic review was to identify the most frequently used quality of life (QOL) assessment tools and to determine how closely these align to the concept of 'survivorship'. Methods: A systematic literature review was conducted according to PRISMA guidelines. Embase, Medline and the Cochrane Library were electronically searched till January 2022 for studies reporting on QOL in aortic dissection patients. Observational studies and case series studies were included. Due to the degree of heterogeneity existing between the studies, a meta-analysis was not conduced. Study quality was assessed using the Agency for Healthcare Research and Quality (ARHQ) methodology checklist. Results: A total of 27 studies were included, encompassing 32 QOL tools. The most common QOL tool utilised was the SF-36, across 11 studies. Only one qualitative study investigated patient perspectives of living with aortic dissection. Overall, QOL was found to be poor in aortic dissection survivors. All identified QOL tools demonstrated a poor alignment with the survivorship domains. Included studies displayed a moderate to high risk of bias, having small sample sizes and an insufficient follow-up period. Conclusion: This review highlights the absence of an aortic dissection specific QOL tool. All QOL tools identified failed to encompass the breadth of survivorship domains, with a lack of studies focusing on the patients’ perspective. Further research is urgently required to gain an insight into the quality of life of patients who have survived an aortic dissection, and to develop an aortic dissection specific QOL tool, underpinned by the survivorship domains.